The Role of CT Angiography in the Diagnosis of Blunt Traumatic Thoracic Aortic Disruption and Unsuspected Carotid Artery Injury

Methodius-Ngwodo, Walaya C; Burkett, Allison B.; Kochupura, Paul V.; Wellons, Eric D.; Fuhrman, George M.; Rosenthal, David

doi:10.1177/000313480807400703

Cited by 19 publications

(7 citation statements)

References 49 publications

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“…All of these factors may have played a role in reducing our mortality rate for major thoracic injuries from 73 per cent (Level II time period) to 30 per cent (Level I time period). Our mortality rates are probably higher than those reported from urban trauma centers, [14][15][16] but they are comparable to reports from predominantly rural population-based centers. 9 Cook 17 also reported a dramatic decrease in mortality after blunt thoracic aortic injury when the period from 1975 to 1990 (65%) was compared with the time period 2000 to 2005 (26%).…”

Section: Discussionsupporting

confidence: 67%

Level I Verification Is Associated with a Decreased Mortality Rate after Major Torso Vascular Injuries

Norwood

Cook

Berne

2011

The American Surgeon™

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Major torso vascular injuries (MTVIs) are frequently fatal. Our purpose was to determine whether the American College of Surgeons’ (ACS) trauma center level of verification was associated with reduced mortality rates in a rural population-based community trauma center. Patients with blunt and penetrating MTVIs were retrospectively reviewed. Mortality rates were compared between Level II and Level I verification time periods. The primary outcome measured was death from MTVIs. Two hundred seventy-four patients (blunt, 167 [61%]; penetrating, 107 [39%]) representing 1.5 per cent of all trauma admissions were studied. Mortality decreased from 41 of 80 (51%) (Level II) to 60 of 194 (31%) (Level I) ( P = 0.002) for the entire group. Mortality reduction occurred primarily in the subgroup with blunt and penetrating thoracic injuries (Level II, 24 of 33 [73%] vs Level I, 25 of 82 [30%]; P < 0.001). A significant reduction was not observed in patients with major abdominal vascular injuries (Level II, 17 of 47 [36%] vs Level I, 35 of 112 [31%]; P = 0.581). Level I status was associated with an overall decreased mortality rate from MTVIs despite low patient numbers. The commitment of hospital resources that are required to achieve Level I ACS verification in a community hospital improves survival, particularly in patients with blunt and penetrating thoracic injuries.

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Section: Discussionsupporting

confidence: 67%

Level I Verification Is Associated with a Decreased Mortality Rate after Major Torso Vascular Injuries

Norwood

Cook

Berne

2011

The American Surgeon™

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“…After review of the abstracts and removal of 53 articles due to reporting reasons (articles that did not report quantitative data on concomitant TAR injuries), 90 articles 6…”

Section: Resultsmentioning

confidence: 99%

Epidemiology of concomitant injuries in traumatic thoracic aortic rupture: A meta-analysis

et al. 2014

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Traumatic thoracic aortic rupture is a highly lethal injury. For those who arrive alive at the hospital, it is of utmost importance to quickly evaluate concomitant injuries and prioritize therapeutic interventions. We aimed to review the frequency of concomitant injuries in patients with thoracic aortic rupture, according to anatomic location and type of injury. A systematic literature search of six medical databases led to the identification of 90 publications; 27 categories of thoracic aortic rupture concomitant injuries were thereafter created. The respective pooled proportions and 95% confidence intervals were calculated and ranked in order of frequency. Among the 7258 patients studied, orthopedic fractures were the most frequent thoracic aortic rupture concomitant injury, amounting to a high pooled proportion of almost 70%, followed by thoracic injury in ∼50% and abdominal injury in over 40%. Pooled proportion for any type of head injury was also high (37%) pointing to the multiple-injury type of lesions among thoracic aortic rupture victims. Thoracic aortic rupture is a devastating injury, but rarely occurs as a sole traumatic entity. The recognition of concomitant thoracic, abdominal, head injuries and fractures after thoracic aortic rupture is of paramount importance. Future studies should focus on the impact of these injuries upon survival, morbidity and disability of multiple-injured thoracic aortic rupture patients.

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“…CTA findings [ 13 , 14 ] of aortic dissection include intimal and calcified internal shift, division of the aorta into true and false lumens by an intimal flap and formation of a double-lumen aorta. The presence of pleural and pericardial effusions can clarify the involvement of aortic branches such as the brachiocephalic trunk of the aortic arch and right internal carotid, subclavian, visceral superior mesenteric, renal, and iliac arteries.…”

Section: Discussionmentioning

confidence: 99%

Early Diagnosis and Treatment of Nine Patients with Severe Multiple Injuries Accompanied by Traumatic Aortic Dissection during Emergency Treatment

Zhang

et al. 2022

Disease Markers

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Objective. This study is aimed at investigating the early diagnosis and efficacy of emergency treatments of nine patients with severe multiple injuries accompanied by traumatic aortic dissection (TAD). Methods. Patients who sustained severe multiple injuries accompanied by TAD following a car accident ( n = 6 ) and falls from a height ( n = 3 ) were treated in the emergency department of our hospital from October 2017 to July 2021. Data of these patients, including seven men and two women (average age, 53 ± 15.2 years; range, 18–83 years) were analysed retrospectively. Upon hospital arrival, the multidisciplinary treatment (MDT) trauma team, composed of doctors and nurses, immediately performed resuscitation following the Green Channel Consultation and Treatment Process for Severe Multiple Injuries. Life-threatening injuries were managed urgently. Blood tests and blood preparation and bedside B-scan ultrasonography and CT were performed. Aortic computed tomography angiography (CTA) was conducted decisively in patients suspected of TAD so that endovascular graft exclusion (EVGE) with the aortic covered stent can be performed promptly, followed by emergency management, second-stage surgery, and intensive care according to the injury control strategy. Results. This study included nine patients suffering from severe multiple injuries accompanied by Stanford type B TAD, with injury severity scores ranging from 35 to 43 points. Six patients underwent EVGE while receiving emergency treatment, whereas two patients who also had intracranial haemorrhage underwent selective EVGE. One case of TAD missed in the emergency department was detected 13 days after hospitalisation; therefore, the patient promptly underwent EVGE. Emergency procedures performed included exploratory laparotomy and splenectomy ( n = 2 ), thoracic closed drainage ( n = 5 ), haemothoracotomy ( n = 3 ), second-stage fracture surgery ( n = 4 ), and tracheotomy ( n = 1 ). Postinjury complications included haemorrhagic shock, coagulation disorders, hyoxaemia, pulmonary infection, renal insufficiency, and hypoproteinaemia; however, all patients recovered after intensive care treatment. Aortic CTA after EVGE revealed the disappearance of the dissection and the resorption of the intermural haematoma. However, varying degrees of stenosis or occlusion were observed in the left subclavian artery. Nine patients with severe multiple injuries were treated satisfactorily by the MDT, without fatalities, and all patients were discharged for rehabilitation. Conclusion. In this study, procedures including resuscitation, urgent aortic CTA for definitive diagnosis, prompt EVGE, emergency injury control surgery, second-stage definitive surgery, intensive care treatment, and rehabilitation were rationally performed by the emergency MDT trauma team. Overall, this continuous and seamless process is a key factor for the successful treatment of patients with severe multiple injuries accompanied by TAD.

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The Role of CT Angiography in the Diagnosis of Blunt Traumatic Thoracic Aortic Disruption and Unsuspected Carotid Artery Injury

Cited by 19 publications

References 49 publications

Level I Verification Is Associated with a Decreased Mortality Rate after Major Torso Vascular Injuries

Level I Verification Is Associated with a Decreased Mortality Rate after Major Torso Vascular Injuries

Epidemiology of concomitant injuries in traumatic thoracic aortic rupture: A meta-analysis

Early Diagnosis and Treatment of Nine Patients with Severe Multiple Injuries Accompanied by Traumatic Aortic Dissection during Emergency Treatment

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